| NPI | 1023652310 |
|---|---|
| Former Name | STEPHANIE JAN REICHARDT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 9717-33) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WI 9717-33) |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2021-01-13 |